Provider Demographics
NPI:1245318724
Name:BOCK, ERICH V (PODIATRIST)
Entity type:Individual
Prefix:
First Name:ERICH
Middle Name:V
Last Name:BOCK
Suffix:
Gender:M
Credentials:PODIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3160
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:7320 N LA CHOLLA BLVD
Practice Address - Street 2:STE 154-214
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2309
Practice Address - Country:US
Practice Address - Phone:520-219-1477
Practice Address - Fax:520-797-1254
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ138213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5949410001Medicare NSC
AZT41410Medicare UPIN
AZZ113888Medicare PIN